After the 1995 Swedish Mental Health Care Reform - a follow-up study of a group of severely mentally ill

Abstract

Aims: The overall aim of this thesis was to follow up a sample of severely mentally ill persons after the 1995 Swedish mental health care reform and to assess if the observed changes were in accord with the aims of the reform. Methods: In 1995/96, 602 persons were surveyed and identified as severely mentally ill in a defined area of Sweden. In 2000/2001, 828 persons were surveyed using the same method. The surveyed persons were interviewed and their needs were assessed on both occasions. Study I involved the 378 persons surveyed on both occasions. The results of interviews and assessments of needs from the two occasions were compared. In Study II, the results of the interviews and need assessment in 1995/96 and in 2000/2001 were compared. The subset of the group surveyed in 2000/2001 that also was surveyed in 1995/96 (n=378) was compared to the group that was “new” in 2000/2001 (n=450). In study III the persons surveyed in 1995/96 but not in 2000/2001 (n=224) were investigated with respect to recovery. A small sample also participated in an interview particularly focusing on recovery. Study IV was a case register study, assessing the quantity of psychiatric care delivered during the period 1994-2003. Results: In general, the results were in accord with the aims of the reform. The number of met needs had increased and the number of unmet needs had decreased. Furthermore, efforts by psychiatric care and social services had increased for the target group of the reform. The objectives of the reform thus seemed to have been effectuated. There seemed to have been a change in the interpretation and application of the concept severely mentally ill between 1995/96 and 2000/2001. It appeared that the threshold for applying the concept had been lowered on the second survey. Only 14 % were considered to have recovered from being severely mentally ill between the two surveys. Conclusions: The findings were in accord with the aims of the reform. Why then is the reform commonly considered a failure in the public debate? The main argument for dubbing the reform a failure may be the fact that the severely mentally ill as a goup are still very underprivileged and that they are clearly not afforded opportunities equal to those enjoyed by society at large.